Health services uptake among nomadic pastoralist populations in Africa: A systematic review of the literature

Abstract

The estimated 50 million nomadic pastoralists in Africa are among the most "hard-to-reach" populations for health-service delivery. While data are limited, some studies have identified these communities as potential disease reservoirs relevant to neglected tropical disease programs, particularly those slated for elimination and eradication. Although previous literature has emphasized the role of these populations' mobility, the full range of factors influencing health service utilization has not been examined systematically. We systematically reviewed empirical literature on health services uptake among African nomadic pastoralists from seven online journal databases. Papers meeting inclusion criteria were reviewed using STROBE-and PRISMA-derived guidelines. Study characteristics were summarized quantitatively, and 10 key themes were identified through inductive qualitative coding. One-hundred two papers published between 1974-2019 presenting data from 16 African countries met our inclusion criteria. Among the indicators of study-reporting quality, limitations (37%) and data analysis were most frequently omitted (18%). We identified supply-and demandside influences on health services uptake that related to geographic access (79%); service quality (90%); disease-specific knowledge and awareness of health services (59%); patient costs (35%); contextual tailoring of interventions (75%); social structure and gender (50%); subjects' beliefs, behaviors, and attitudes (43%); political will (14%); social, political, and armed conflict (30%); and community agency (10%). A range of context-specific factors beyond distance to facilities or population mobility affects health service uptake. Approaches tailored to the nomadic pastoralist lifeway, e.g., that integrated human and veterinary health service delivery (a.k.a., "One Health") and initiatives that engaged communities in program design to address social structures were especially promising. Better causal PLOS NEGLECTED TROPICAL DISEASES

Reproductive health decision making among nomadic pastoralists in North Eastern Kenya: a qualitative social network analysis

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“…The results from this study also show that the challenges affecting the access of nomadic communities to prevention and care for many diseases 10,13,25 are also true for COVID-19, COVID-19 INFORMATION AND PROTECTIVE MEASURES WITHIN NOMADS with remote location, financial constraints, and poor access to water and sanitation being predominant. It is thus critical that future COVID-19 prevention measures account for these challenges and make specific provisions to address them.…”

Leaving no one behind: targeting mobile and migrant populations with health interventions for disease elimination—a descriptive systematic review

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“…Second, NTDs could be re-established in areas where these have been eliminated (e.g., if MMPs affected by NTDs migrate to an area where MDAs have stopped). Third, NTD interventions often face challenges in targeting MMPs, due to their limited geographic access to health facilities and NTD testing, poor existing health service quality delivered to these populations, interruptions in treatment supply, high out-of-pocket payment and travel costs, and low awareness of and alternative beliefs on NTDs and treatment [ 6 , 7 ]. In other circumstances, MMPs may be excluded from health programming due to cultural and language barriers, as well as stigma, possible illegal status, resulting in a fear of deportation [ 8 ].…”